Is the payer environment looking up for ASCs?

In the wake of CMS' increasing ASC payment rates to 3.8 percent and adding four procedures to the list of covered ASC operations in its 2023 "Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Proposed Rule," the payer environment for surgery centers is showing signs of improvement.

Two healthcare leaders connected with Becker's to answer, "What does 2023 have in store for the ASC industry?"

Editor's note: Responses have been lightly edited for length and clarity.

Terri Cascia. Market Operations Manager at Tenet Healthcare (Dallas): 2023 should be a year of growth for the ASC industry. With 26 newly covered ASC procedures being added for payment by insurance payers and many of those being cardiology geared such as implantable devices and revascularization via stents, there is sure to be a higher demand and better payout for ASC locations and their providers.

ASC care allows for a more streamlined and personal experience for patients and now adding additional paid procedures, the demand and growth are inevitable. Allowing a care environment that incorporates more complex procedures for a fraction of the cost and same day patient discharge, will also open up surgical suites and hospital admitting beds for those who can't be treated at an ASC but have been currently unavailable or backlogged.

Operational leadership should be prepared to be aggressive, yet strategic with their 2023 plans to account for the potential growth.

Susan Feigenbaum, PhD. Practice Administrator at Pepose Vision Institute (St. Louis and Chesterfield, Mo.): On a positive note, ASC payment rates will increase overall by 3.8 percent in 2023 due to their alignment with the hospital market basket. Also, a complexity adjustment has been added in the payment rate for specific surgical procedures, creating an incentive to perform more of these in an ASC setting. Countervailing forces include the 4 percent cut in reimbursement for physician services, which will provide additional impetus for senior surgeons to retire or cut back significantly, while the younger physician cohort may find hospital-based employment increasingly more attractive. Both trends bode poorly for overall ASC volume. Tight labor market conditions will continue to drive ASC costs up, given that the bulk of layoffs in 2023 will come from the high-tech and financial sectors, not the medical industry.  If these layoffs are deep and persistent, they will weaken demand for elective procedures — the "bread and butter" of ASCs — through the end of 2023.

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